Short term outcome in severe alcoholic hepatitis patients treated with Methylprednisolone plus N acetylcysteine or Pentoxifylline plus N acetylcysteine.
Abstract
Introduction: Severe Alcoholic hepatitis (AH) is an acute form
of alcohol induced liver injury. Often it present as fetal diseases
with very high (30-50%) short term (28 days) mortality. This study
was conducted from period May 2016 to July 2017 in Liver unit,
Bir hospital. The main objective was to find out 28 days mortality
in patients with severe alcoholic hepatitis who had Discriminant
function (DF) ≥ 32. This was a prospective, comparative, randomized
interventional hospital based study.
Methodology: Hundred and ten diagnosed patients of severe
alcoholic hepatitis who fulfilled the criteria were enrolled and
randomized into two groups (odd number and even number). Group
1 received methylprednisolone and group 2 received pentoxifylline
for 28 days. In both groups N acetylcysteine were added. Lille score
was calculated in methylprednisolone group at day 7 and patients
with score of ≤ 0.45 were continued methylprednisolone for total
28 days otherwise stopped. Data were recollected at day 28. They
were compared in relation to survival, complications of drugs and
causes of mortality.
Results: Mean age of presentation were 40.21±10.5 yrs in
methylprednisolone and 42.1±12.1 yrs in pentoxifylline group.
In both groups complications were nausea, vomiting, bloating,
anorexia and swelling of limb. However, hyperglycemia (16.4%) and
renal impairment (9.1%) were more common in methylprednisolone
group. Mortality rates were 34.5% in methylprednisolone and 37.8%
in pentoxifylline group within 28 days. Common causes of death in
both groups were hepatic encephalopathy, hepatorenal syndrome,
sepsis or the cause was undetermined.
Conclusion: Alcoholic hepatitis is common manifestation of
alcoholic liver disease with high short term mortality in both the
groups however adverse effects of drugs are more common in
methylprednisolone groups.